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HomeMy WebLinkAbout11875-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.. 71.2695 Date Aug. 10 19 84 THIS CERTIFIES that the buildin Pool , Fence , Deck 6455 g ..... d6~h'~!) ' i~l'.' ' ~ ~ .......... I;I~.)c'{ J,~xi~b'l( ....... Location of Property ... $ 9 ............... C.o. ~.k.l.~.n...gQ: .......... Mattituck House No. Street Hamlet County Tax Map No. 1000 Section ... ~..3 ~) ...... Block ...0. 4. .......... Lot . .0.~. 0. ............ Subdivision...G.a..r.cl.e.n...Hg.h.~ s,.. ............. Filed Map No..5.7. 7. .... Lot No. 1. 7..&...1.8 ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... A.u. ~r: .......2.0..., 19.8.2. pursuant to which Building Permit No.. 11875 ~ dated ....... A.u.~.. ....¢ .4 ........... 1913.2., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... The certificate is issued to .... O'O~IR .I:It3~q~. S ~I,I~E ..................................... (owner, ~. ~ of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO .... .Iq.5. 7. .6.1.3.6. ..................................... Building Inspector Rev, 1/81 FOI1M lqO. 2 TOWN oF ,~OUTHG~D TOWN HALL SOUTHOLD, H. Y. BUILDING P'E PJvU T, (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL I~ULL COMPLETION OF THE WORK AUTHORIZED) ~ ; N°. 1157~ Z Permission is hereby granted to ......~.~ ./.~...~..,,J~/~,~..... ./.~, , ........ ~o ....~.~. at premises 4 ....... ....~,/_-~....~../,.7..:~.....Z~... Couhty Tax Map No. 1000 Section ~.~..Z.'.~. ......... ,. Block Lo..~. ...... : ....... Lot No...OZ(D ........ pu~uant to application dated ..... ~ ............... ~:..~%...., 1~ and approved by the 8uil~ln~ Inspector. ........................ Buddin I~ector Rev. 6/30/80 ~ L . ; , ' FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ,~;~uthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions Bo This application must be filled in typewriter OR ink, and submitted-~=dupl~,=tc to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual naturel or topographic featu res. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and.installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1, Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings, 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. Co Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land 3. Copy of certificate of occupancy $1.00 use --Pre-Existing C.O. $15,00 Vacant land C.O, $ 5.00 New Building .... .X ........ Old or Pre-existing Building ............ Vacant Land ............. 6455 County Rd. 48 Mattituck Location of Property . 50.. Conklln Rd. Mattituck House No. Street Hamlet 0 JOHN HENRY SHIP Owner or wners of Property ............................................................ County Tax Map No. 1000 Section ...%$.9 ......... Brock ... 9.4. ......... Lot ..... 0.!9 ........ Subdivision ....... ~.C~,~.f'.~..'e-~...~V~...~.'...Filed'Map No..~..'~.09...Lot No..~-.... ~ .'~.~.~.~. ~. P. ~. ~ ~ .8.2. Appli ermit No. ~.1.~'~ ~5;5... Date of Permit . .8./. cant .................................. Health Dept. Approval ..........N/A ............. . Labor Dept. Approval ..................... ... Underwriters Approval........................N576136 Planning B~ard Approval ..................... . Request for Temporary Certificate ..................... Final Certificate .. Fee Submitted ~[C~onstruction ~ above described building and permit meets all applicable codes and regulations. ~) ~y_~toq~-" Applicant . .. J. ohn. ~tenr~..Ship ...... Rev. 10-I0~78 loooe63 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NE~W YORK 10038 V.te Sept:ember 14, 1982 JpplicatlonNo. oa~file 183878--82 N 576136 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant framed on the above application number in the premises of John H. Ship, 100 grand Ave., Ma~tituck, N.Y. in the following location; [] Basement [] 1st Fl. [] 2nd FI. OLl~Sid~ Section Block Lot was examined on September 9, 1982 and fou.d to be in compliance with the requirements of this Board. FIXTURE OUTLETS DRYERS IECEPTACLES SWITCHES FIXTURES RANGES OVENS DISH WASHER 2 FtUORE$CENT SYSTEMS NO. OF FEET S E R I C E NO, O E COND. OF '~C C©ND. NO OF HI LEG OF HI LEG OTHER APPARATUS: (bWirm~%g,Pool) ~Tgis cea~ifica~e cover~ ~ aC ~ ~e ~ ~p~n ~ly. ~ by a q~i~ed p~son. ~ i~.F.C.I. AW, G OF NEUTRAL Glean R. Bradley RFD 169 Horcon Ave. Matcituak, N.Y. 11952 COPY THIS OF ANY i ~t ~3 FI_~ELD I~SPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL COMMENTS ADDITIONAL COMMENTS: FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 _/ TEL.: 765-1803 Examined.~,,~...~. .... , Approve~i...~...~. ..... 1~..~rmit No...,/~.~..~.Z · Disapproved a/c . Y~. .......... i ................ ~ 0tu'fldin~ In~*ctor) ,I~PLICATION FOR BUILDING ~E~MIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to .t~,e Building Inspector, with 3 sets of plans, accurate plot plan to gale. Fee according to schedule. b. Plot plan showi~g location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a ~letailed description of layout of property must be drawn on the diagram which is part of this appli- cation;thee, work cove~ed by this application may not be commenced before issuance of Building Permit. d. Upon spproval,~of this application, the Building Inspecto~ will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to ~e Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New yOrk, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant a~rees to comply with all applicable laws, ordinances, J~lding code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necesas~ bisections. I/! ~ A , . ~ .l..ag,_.. ......... (Signature of applicant, or n~i~, if a corporation) .6.~.. ~. ~ .... /~ ~.zz.,.r~.~c..a..~../(~.~- (Msillng address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... /7.-./'/.~/~ ~ · -":...r.~.r..,... z~¢~ ..... .C. ~.... C.c~..~c. ~ ............................ Name of owner of premises ......... "~...0..~ ..... /-~/~. .... .~/4t. ! .~. .................................. (as on the tax roll or latest deed) If app~aq~ a corporation, isi~nature of ~uly authorized officer. .... .... .... // (Name and rifle/of corp//r~ oflker) Builder's License No ...... ~.?~ .'. J~....'7'... ~.O Plumber's License No ......................... Electrician's License No ....................... · ,, Other Tre. de's License No ...................... PERMIT INCLUDES APPROVAL TO REMOVE EXCESS FILL FROM ABOVE PREMISES BY REGRADING LOT DRIVEWAY CONSTRUCTION CESSPOOL CONSi RUCTION CELLAR CONSTRUCTION o~-~ 1. Location of land on, whil~ proposed work will be done .................................................. ~.~.. ~,..~.-..~'. ......................... ~ ............... /'~,,nTr. ~.77,¢~... N.. Y. .......... House Number -"' Street Hamlet County Tax Map No. 1000 Section .... /.~.~ ......... Block ...... .~. .......... Lot ..... /~/~ ........... Subdivision .... .~./~.~. .... ~/~.~. ~. ......... Filed Map NO .... ~.~. ?. .... Lot.../. ?..~../.~.. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing Use and occupancy .......... ~ .~. ~.~.'~..'('L~..tv. ........ :...: .............................. " . ' ' "...P.~OM .... .,e"-.~,,o.¢_-~. .... b. Intended Use and occupancy .......... /~...~. (.O~0.. 7.hq~-.....~l~.,~,. ~. .4,u~.zo,rc,,,,~:-' ' ,~:. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alterati?.. '~'t9 ....... Repair .............. RemOval .............. Demolition .............. Other Work...~..~ ....... I (Description) 4. Estimated Cost ...... g~.g .(~ .......................... Fee .................................. (to be paid on filing this application) 5. If dwelling, number of dwelling[units ............... Number of dwelling units on each floor ................ If garage, number of cars .... i .............................. ..................................... 6. If business, commercial or mixe!d occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing strncturcs, ifany: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... i. ·. Height ...................... Numberer Stories ................. 8. Dimensions of entire new construction: Front ...... /.~. ...... Rear....3..~......... ip'ti ............... Height .............. : .Number of Stories ........................................................ 9. Size of lot. Front ...................... Rear ...................... Dept .... ~' ............. 10. Date 0fPurchase .......... i ....... ............ Name of Former Owner ............................. 1 1. Zone or use district in which p~emises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... ]~/! ........... fi.~. ·. 13. Will ldt be regraded ....... ~..O .................. Will excess fill be removed from premises: ~ No 14. Name of Owner of premises .. ~ .................. Address ................... Phone No ................ Name of Architect ......... ' .................. Address ................... Phone No ................ Name of Contractor .../9. :. t~.~..'7.t'~.~. . ~..37..°.~°.~. · · · Address . .ff0.~.r..F?.7~.. iq/ff.. Phone No...~.~. ~':.~.(~..~'... PLOT DIAGRAM Locatei clearly and distinctly ali buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and bloc~ number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEIt~JOR~,.~. ~,~.,'.' S S o, ...... .~.... . . i' . .... sworn, ~ being duly deposes and says that he is the applicant above named. He is the ................ >.~.~ .: ................ , ' : ~(Contracto_.~r~ent,. corporate officer etc.) of said owner or owners, and is d¢ly authorized to perform or have performed the said work and to make and file this application; that all statements cor~tained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........ .~q-.~...L~.~. .... clay ~ .... ~ .... , l~.. , Notary P.ublic, . ...... ~ ...... ..~.~. County . . . 7/. .ct /. . ....... : .... ' ~l,"~*'~ vo~ ~dg~fiature of applicant) Nd, 52.8125850, Suffolk g~rm Expires March 30, 19 ,